Organization
DALE GRAY M.D.,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE GRAY MD (PRESIDENT)
(815) 962-0633
Entity
Organization
Contact information
Practice address
2720 GLENWOOD CT, ROCKFORD, IL 61101-3507
(815) 962-0633
(815) 962-0142
Mailing address
2720 GLENWOOD CT, ROCKFORD, IL 61101-3507
(815) 962-0633
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036072289
IL
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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